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«^'~ . ^. . CLINICALo o* ScienceDirect psychology

REVIEW

ELSEVIER Clinical Psychology Review xx(2007) xxx- xxx

Empirical evidence of cognitive vulnerability for depressionamong children and adolescents: A cognitive

science and developmental perspective

Rachel H. Jacobs3'*, Mark A. Reineckea'b, Jackie K. Gollana'c, Peter Kanea'd0Department ofPsychiatry Division ofPsycliology and Behavioral Sciences atNorthwestern University Feinberg School ofMedicine.

United States

bNorthwestern University Feinberg School ofMedicine, 710 N. Lake Shore Drive, Abbott Hall Suite 1205, Chicago. Illinois 60611, United StatescNorthwestern University Feinberg School ofMedicine, 446 E. Ontario St. Suite 7-100. Chicago. Illinois 60611. United StatesdNorthwestern University Feinberg School ofMedicine. 446 E. Ontario St. Suite 7-100, Chicago, Illinois 60611. United States

Received 11 September 2007; received in revised form 23 October 2007; accepted 29 October 2007

Abstract

We summarize and integrate research oncognitive vulnerability todepression among children and adolescents. We first reviewprospective longitudinal studies ofthe most researched cognitive vulnerability factors (attributional style, dysfunctional attitudes,and self-perception) anddepression among youth. We next review research oninformation processing biases inyouth. We proposethat theintegration of these two literatures will result ina more adequate testof cognitive vulnerability models. Last, weoutline aprogram of research addressing methodological, statistical, and scientific limitations in the cognitive vulnerability literature.© 2007 Elsevier Ltd. All rights reserved.

Keywords: Cognitive vulnerability; Information processing; Depression

Contents

1. Introduction 01.1. Development of depression 01.2. Theoretical hypotheses ofcognitive vulnerability models 01.3. Cognitive development 0

2. Attributional style 02.1. Review . 0

3. Dysfunctional attitudes 03.1. Review 0

* Correspondingauthor. NorthwesternUniversity Feinberg School of Medicine, 710 N. Lake Shore Drive, Abbott Hall Suite 1205, Chicago,Illinois 60611, United States. Tel: +1 312 835 1568; fax: +1 312 926 0406.

E-mailaddresses: rlijacobs@northwestern.edu (R.H. Jacobs),m-reinccke@northwestern.edu (MA. Reinecke),j-gollan@northwestem.edu(J.K. Gollan), p-kanc@northwcstem.edu (P. Kane).

0272-7358/$ - see front matter © 2007 ElsevierLtd. All rights reserved,doi:10.1016/j.cpr.2007.10.006

Pleasecite thisarticleas: Jacobs, R. H., et aL,Empirical evidence of cognitive vulnerability fordepression amongchildrenandadolescents: Acognitive scienceand developmental perspective, Clinical Psychology Review (2007), doi:10.1016/j.cpr.2007.10.006

! R.H. Jacobs et al. / Clinical Psychology Review xx (2007) xxx-xxx

4. Self-perception 04.1. Review 0

5. An integrative perspective 05.1. Review 0

6. Discussion 0

6.1. Future research 0

Acknowledgements 0References 0

1. Introduction

Using a developmental and cognitive science framework, we review and integrate recent research on cognitivevulnerability to depression among children andadolescents. First, wereview prospective longitudinal studies assessingrelations between putative cognitive vulnerabilities and the occurrence of depression. We then propose that theincorporation of experimental paradigms andthe assessment of information processing biases among children mayfacilitate the testing of alternative cognitive vulnerability models. Last, we outline a program of research addressingmethodological, statistical, and scientific limitations in this literature.

/./. Development ofdepression

Major depressive disorder (MDD) oftenbegins during adolescence, is chronic andrecurrent, and frequently placesyouth at risk for recurrent MDDduring adulthood. Between 20%and50%percent of adolescents report experiencingsubsyndromal levels of depression (Kessler, Avenevoli, & Merikangas, 2001; Petersen, Compas, Brooks-Gunn, &Sternmler, 1993). Lifetime prevalence rates of 1.5% (e.g., Costello etal., 1996) and7%(e.g., Kessler etal.,2005) havebeenreported for depressive disorders amongchildren and adolescents, respectively. Depression duringadolescencesharesfeatures ofthe depression that occursduringadulthood (e.g.,Lewinsohn, Allen, Seeley, & Gotlib, 1999; Pine,Cohen, Gurley, Brook, & Ma, 1998). Adolescence, then, represents a critical period of vulnerability. Seventy-fivepercentof adultswith MDD experience their first depressive episode duringchildhoodor adolescence, whereasonly25%experience onsetofMDDin adulthood (Kim-Cohen et al.,2003). Thatsaid,patternsof depressive symptomsmaydifferover the course of development given the cognitive, social, emotional, and biological changes that transpire(Cicchetti & Toth, 1998; Weiss & Garber, 2003). In addition, the observed genderdifference in depression emergesin early adolescence (e.g., Angold, Erkanli, Silberg, Eaves, & Costello, 2002; Weissman, Warner, Wickramaratne,Moreau, & Oltson, 1997). Depression is a common, persistent, andpernicious occurrence in the lives ofyouth.Anycomprehensive model ofvulnerability for depression must address these observations.

1.2. Theoretical hypotheses ofcognitive vulnerability models

Several models have been proposed to explain the development and maintenance of depression among youth.Cognitive vulnerability modelsstand at the forefront ofresearch activity. Beck (1967)definedcognitive vulnerabilityas the presenceofmaladaptiveself-schemareflectingthemesofhelplessness andunlovabilitythat becomeactivatedbynegative life events or negative moods. Many cognitive vulnerability theories employ a vulnerability-stress paradigm(e.g., Abramson, Seligman, & Teasdale, 1978; Beck, 1967), whereby cognitive factors interact with environmentalstressors to increase risk for emotional disorders. Indeed, stressful life experiencespredict depression among childrenand adolescents (see Grant et al., 2004a; Grant, Compas, Thurm, McMahon, & Gipson, 2004b). This relationshipappears to be bidirectional, as depressive symptoms also predict increases in objectively assessed stressors amongyouth (Grant et al., 2004b). The assessment of stress in the study of cognitivevulnerability is crucial, as exposure tomild uncontrollable stress during adolescence can impaircognitive functioning (Steinberg, 2004).

Specific criteria for defining cognitive vulnerabihty factors have been put forth. First, a cognitive vulnerabilityfector must temporally precede depression andexhibit stability overtime (e.g., Alloy et al., 1999; Ingram, Miranda,& Segal, 1998). Second, construct validity must be established, in that the cognitive vulnerability fector mustdemonstrate predictive validity not better accounted for by an extraneous variable. Third, cognitive vulnerability

Please cite thisarticle as: Jacobs, R. H.,et aL, Empirical evidence of cognitive vulnerability fordepression among children andadolescents: Acognitive science and developmental perspective, Clinical Psychology Review (2007), doi:10J016/j.cpr.2007.10.006

RJI. Jacobs et al. / Clinical Psychology Reviewxx (2007) xxx-xxx 3

factors arebelieved tobespecific to particulardisorders. Forexample, ifdysfunctional attitudes serveasavulnerabilityfordepression, they must notalso predict conduct disorder (discriminant validity). Fourth, vulnerability isviewed asanendogenous process thatis conceptualized as latent(e.g., Ingram et al., 1998). Thatis, the vulnerability mustrepresentan enduring characteristic of thechild, andnottheir family, relationships, or environment These general andspecifictheoretical hypotheses guide the scientific exploration of cognitive vulnerability.

1.3. Cognitive development

Adolescence represents a phase wherein cognitive vulnerability may occur andis likely to emerge. The cognitivedevelopmental 'prerequisites' arepresent and can emerge (Alloy, Abramson, Walshaw, Keyser, &Gerstein, 2006). Theadolescent transition ischaracterized bytheemergence ofa more self-directed andself-regulated mind (Keating, 2004).Self-regulation is advanced through an executive suite of capabilities (Donald, 2001) as central conceptual structurescoordinate across domains (Keating, 1996). A developing executive control monitors andmanages cognitive resourcesduring adolescence (Kuhn & Pease, 2006). Thus, across development, increasing executive functioning abilitytranslates to an increasingly 'top down' mode of cognition.

A parallel coordination of information processing, or 'bottom-up' components allows for the strategic use ofemerging cognitive resources. In such, information processing and cognitive reasoning operate in concert. Indeed,recentworkreveals thatadvances in levelofreasoning aresupported by 'bottom-up'changesin efficiency andworkingmemory (Demetriou, Christou, Spanoudis, & Platsidou, 2002). These processes, in turn, are reciprocally affectedby 'top down' cognition. Moreover, processing speed increases from early childhood through mid-adolescence(Demetriou et al., 2002). Forexample, adolescents arebetter able to ignore irrelevant stimuli on the Stroop taskthanchildren (Demetriou, Efklides, &Platsidou, 1993). Increasing processing speed leads to greater efficiency intopdownprocesses, including social problem solving. Such research suggests that adolescents possess the cognitiveprerequisites for vulnerabilities to depression. If cognitive vulnerability is a valid model representing the onset ofdepression among youth, we expect children to be capable of demonstrating maladaptive cognitions, which, ininteraction with the stress of the adolescent transition, result in depressive disorders.

2. Attributional style

Attributional style is thecognitive vulnerability fector thathasgarnered themost research and theoretical attention.First proposed as a means of addressing limitations in theoriginal theory of learned helplessness (Seligman, 1975),Abramson et al. (1978) proposed thatdepressed individuals attribute negative events to internal, global, andstablecauses. In contrast, viewing the causes of negative events as external, specific, andunstable represents a positive oradaptive style, andmay buffer orprotect an individual from depression. A negative attributional style is hypothesizedto be a proximal contributor to the onset of depression. In further theoretical modification, hopelessness theory(Abramson, Metalsky, &Alloy, 1989), introduced three separate cognitions thatcontribute to depression—a lowsenseofefficacy following life stress, viewing negative events ashaving negative consequences, andviewing thecauses ofthese events as global and stable. These cognitions evolve into hopelessness, which is hypothesized to be a proximal and sufficient cause of depression. Hopelessness depression reflects motivational deficits and dysphoric affectstemming from a negative attributional style (Abramson, Alloy, & Metalsky, 1988). An elaborated cognitivevulnerability-transactional stress depression model (Hankin &Abramson, 2001) accounts forthegeneral developmentofdepression aswell as specific outcomes, such astheemergence ofa gender difference in depression. In this model,negative events contribute to initial elevations ofgeneral negative affect Cognitive vulnerabilities suchas a negativeattributional style, then, moderate risk for depression. Depression, in turn, can lead to more negative life events,creating a pathogenic cycle. Theaforementioned models allseek to explicate therelations between attributional styleand depression.

2.1. Review

Twenty-one studies support the prospective effects of attributional style on depressed mood in children andadolescents (see Table 1). Young children are capable of drawing inferences about events and evidence potentialfor demonstrating a stable attributional style. In one study, third graders demonstrated greater pessimism in their

Please cite this article as: Jacobs; R. H., etaL, Empirical evidence ofcognitive vulnerability for depression among children and adolescents: Acognitive science and developmental perspective, Clinical Psychology Review (2007), doi:10.1016/j.cpr.2007.10.006

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Prospective cognitive contentstudies ofvulnerability to depression amongyouth

Study

AttributionalstyleAbela (2001)

Sample N Age Depression Depression VulnerabiUty Tune Control Life stress(range) status measure measure frame baseline interactionand mean depression? tested?

School 382 3rd (8.9) Sxand 7th

(12.9)

CDI CCSQ,CASQ

6 w CLES

Abela and School 314 3rd (8.8) Sx CDI CCSQ, 6 w X CHAS

Payne(2003) and 7th

(12.8)CASQ

Abela and School 79 (12.3) Sx CDI CCSQ, 10 w X CLES*

Sarin (2002) CASQ weakest link

Abela, Children of 140 6-14 Sx CDI CASQ, iy X Stress of

Skitch, depressed (9.8) CCSQ parentalAdams, and parent onset of

Hankin (2006) depression

Bennett and School 95 11-13 Sx CDI CASQ-R 6m X CHS, LESBates (1995) (12)

Brozina and School 480 8-13 Sx CDI CASQ, 6w X CHAS

Abela (2006) (10.5) CCSQ

Conley et al. School 147 5-10 Sx CDI CASL 3w X DHQ(2001) (8.2) CASQ-R

Dixon, and Ahrcns Summer 84 9-12(11) Sx CDI KASTAN-R lm X Own measure

(1992) camp

Garber et al. School, but 240 (11.9) Sx CDI CASQ 5y X LEIA

(2002) 78% of

children had

mothers with

a history ofmood

disorders

Summary of findings

CASQ x CLES predictedincreases indepressive sx in7th, but not 3rd graders.Attributionsaboutconsequences xCLESpredicteddepression in 3rd and7th,Attributionsaboutself xCLES predicteddepression increases in 3rdand7th gradegirls,but not boysGender and SE moderators of'weakest

link' x CHAS. Boys with low SE and girlswith high SE significant interactionpredicting increases in HS depression sxCLES x'weakest link' predicted increasesinHS depression sx onlyGenderx weaklinkx parental depressionstressor. Childrenwith depressogenicinferentialstyles greater elevations indepression following elevations in parent'slevel ofdepression. Stronger association ingirlsCHS x CASQ predicted CDI, no maineffect ofCASQ. More support found againstvulnerability modelsCASQ x CHAS to predict increase indepression, but only for those with lowdepression at tlCASI main effect, CASI x DHQx ageslightly higher levels of depression inolder childrenthan for younger (allfindings for positive subscale)Hasslesand hasslesx attributionsignificant

Adolescents becoming more negative inCASQ over time also reportinghigherdepression over time. Initiallevel ofstressassociated with trajectoryof depression sx. Reciprocal models alsosupported

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Gibb and School 448

Alloy (2006)

Gibb etal. (2006) School 448

Hamraen Children of 79

et al. (1988) depressedmothers

Hankin, School 270Abramson,and Siler

(2001)

Hilsman and School 439

Garber(1995)

Lewinsohn School 1508

et al. (1994)

Lewinsohn School 1507

et al. (2001)Mccarty, School 331

Vander Stoep,and McCauley(2007)

Nolen-Hceksema, School 168

Girgus, and Seligmanet al. (1986)

Nolen-Hoeksema School 352

etal. (1992)

Panak and School 521

Garber(1992)

9-11(9.8) Sx

9-11(9.8) Sx

(12.5) Dx

14-18 Sx

(16.2)

(11.4)

(16.5)

(16.6)

(12.0)

Sx

Dx

Dx

Sx

(8-11) Sx

3rd and Sx

4th

graders

3rd-5th Sx

graders

CDI CASQ-R 6m X Peer

victimization,

CTQ-EA

CDI CASQ-R 6m X Peer

victimization,CTQ-EA

K-SADS, CASQ 6m X Brown and

CDI Harris

BDI, CASQ-R 5w X

HDSQ-R

CES-D, CASQ Approx XDepressive 2 wAdjectiveChecklist

K-SADS, Items from 1 y XCES-D KASTAN-R

K-SADS, CASQ 1 yCES-D

MFQ CASQ-R 1 y

X

X

APES

Grade deficit

stressor

Measured, but

no interactions

assessed

Brown and

Harris

In 4th gradersCASQ mediates only, 5thgrademediator and moderatoreffects.Depression also predicted negativechangesin CASQ. Best fittingmodelsinclude reciprocal relationsDepression predicted negativechangein CASQ-R

Main effect for stress, but not CASQ

CASQ x APES predicted increasesindepression sx. Gendermoderated thisinteraction for BDI, so held for boysbut not girls. Held forHS depressionsx for both genders,HS did not mediaterelations

Depressivesx predicted by interactions ofnegative explanatorystyle with stressors

Attributions predictedcurrent, past,andfirst episode depression. OR for currenthighestCASQ x LE predictMDD onset, but athigher levels of stressSupport for 'scar' models. Baselinedepression predictiveofmorenegative attributional style

CDI CASQ iy

CDI CASQ 5y

LEQ

LEQ

CASQ predicted depression changes atsome time points over the year. Interactionwith life stress was significantAs childrengrew older, pessimisticexplanatory style significant predictor oflaterdepression. Among youngerchildren,life events only. Modest support fordiathesis-stress. Some evidence of scar

hypothesisPeerrejection Interaction betweenstress (increase in peer(a developmental rejection) andCASQ predicted depressionlife stress

assessment)

CDI CASQ iy

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Table 1 (continued)

Study Sample N Age Depression Depression VulnerabiUty Time(range) status measure measure frameand mean

Control Life stress

baseline interaction

depression? tested?

Prinsteiu and

Aikins (2004)

Prinstein, Chea,

and Guyer(2005)

Robinson,Garber, andHilsman (1995)

School 158

School 159

School 371

15-17

(16.31)

15-17

(16.31)

Sx

Sx

(12.0) Sx

CDI

CDI

CDI

Schwartz and School 397 14-18 Sx BDI

Koenig (1996) (16.0)Southall and School 115 14-19 Sx BDI

Roberts (2002) (16.5)Spence, Sheffield, School 733 12-14 Sx BDI

and Donovan (12.91)(2002)

Toner and School 112 (12.5) Sx "the

Heaven (2005) feel"

Sx CDI

Sx CDI

CASQ 17 m

Own 17m

CASQ 15 m

ASQ 1.5 m X

CASQ 14 w X

CASQ-R 1 y X

I PASS-1

d peer-socialon ILQ attributionaland BDS style scale

CDAS

CDAS

2y

Every X6wfor

iy6w X

Dysfunctional attitude.V

Abela and Children of 140 6-14

Skitch (2007) depressedparents

(10.0)

Abela and School 184 (12.8)Sullivan (2003)

Lewinsohn School 1507 (16.6)et al. (2001)

Dx K-SADS, DAS

CES-Diy

Peerrejection (adevelopmentallife stress

assessment)Peer

victimization

Developed forstudy based onCompas (1987)major eventsand hassles,transition to

junior highLEQ

LES

NLE

CHAS

CHAS

Brown and

Harris

Summary of findings

Peer rejection*CASQ predictive of dep.for girls. Main effect for attributionalstyle overall

Higher levels of critical self-referentattributions associated withprospectiveincreases in

depressive symptoms under conditionsofhigh levelsof boys' peervictimizationMain effect stressors, perceived self-worth.CASQ main and interaction with stressors,3 way interaction with self-worth

Attributions predicted depression

3 way significant interaction and SExCASQ in non-symptomatic at baselineCASQ-R main effect

A post-hoc combinedgenerality attribution(both positiveandnegativeevents tostable/global factors) predicted depression

CDAS x CHAS significant for children withlow self-esteem,also significant for childrenwith low CDAS and high self-esteemCDAS x CHAS predictedincreaseddepression, in those with high, but not lowlevels of self-esteem

DAS xNLE (p=.086) trend at high levelsof stress CASQ x LE predictMDD onsetat higher levels of stress, little effect vs.low levels of stress

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Study Sample N Age Depression Depression Vulnerability Time(range) status measure measure frameand mean

Kistner et al. School

(1999)

Kistner et al. School

(2006)

108,

68 at

follow-up

667

4th and

5th

graders atstart

(9.4)

Sx

Sx

Kistner, David-Ferdon, SchoolLopez, and Dunkl(2007)

Lewinsohn School

et al. (1994)

641

1508

Measelle, Ablow, Cowan,

and Cowan (1998)Community 97

McGrath and School 248

Repetti (2002)

Ohannessian School 75

et al. (1999)

Tram and Cole School 468

(2000)

3rd-5th

graders

(16.5)

(4.6)

(9.5)

(11.8)

13-17

(14.5)

Sx

Dx

Sx

Sx

Sx

Sx

CDI,RADS Harter's SPPC 7y

CDI

CDI

K-SADS,CES-D

BPI

Harter's SPPC 6 m

Harter's SPPC 6 m

iyItems from

Harter's SPPC

BPI 3y

CDI.TRF Harter's SPPC 3y

CES-D Harter's SSPC ly

CDL PNID,TRID

Harter's SPPC Approx6m

Control Life stress

baseline interaction

depression? tested?

X

Measured, butno interactions

assessed

APES

Summary of findings

Perceivedacceptance, but not actualacceptance, predicted depression 7 yearslater

Inaccurate self-perceptions predictedincreases in depressive symptoms anddepressive symptoms predicteddecreased accuracy. Bias didnotpredictchange in depression, rather depressionpredictednegative biasSelf-perception didnot predict changes indepression

Social self-perception predicted currentdepression andprevious depression, butnotfirst onset

Depression-anxiety subscale significantlynegatively correlated with competence andmotivation in Kindergarten and1stgradeNegative self-perceptions andunderestimations not associated with

change in depressionGenderpredicts depression untilself-perception ofathletic competenceis added as covariate

Self-perceived competence predictedchange in depressive symptoms

Note. Age ranges and means reported when available. Grades reported when age data was not available. Sx =symptoms; Dx =diagnosis; CDI =Children's Depression Inventory; CCSQ =Children's Cognitive Style Questionnaire; CASQ « Children's Attributional Style Questionnaire; CASQ-R =Children's Attributional Style Questionnaire-Revised; CLES =The Children'sNegative Life Events Scale; CHAS and CHS =Hassles Scale for Children; weakest =weakest link; LES =Life Events Scale; CASI =The Children's Attributional Style Interview; DHQ =Daily Hassles Questionnaire; KASTAN-R =Children's Attributional Style Questionnaire-Revised; LEIA =Life Events Interview for Adolescents; CTQ-EA « Childhood TraumaQuestionnaire —Emotional Abuse Subscale; K-SADS •» Schedule for Affective Disorders and Schizophrenia for School-Age Children; Brown and Harris =Brown and Harris; 1978; BDI =Beck Depression Inventory; HDSQ-R =Hopelessness Depressive Symptoms Questionnaire-Revised; APES =Adolescent Perceived Events Scale; CES-D =The Center for EpidemiologicalStudies Depression Scale for Children; MFQ =The Mood and Feelings Questionnaire; LEQ =Life Events Questionnaire; NLE » Negative Life Events assessed as modified version ofLifeEvent Record; ILQ - Illinois Loneliness Questionnaire; BDS =Birleson Depression Scale; PASS-1 =Peer-social Attributional Style Scale; ASQ =Attributional Style Questionnaire; CDAS =Children's Dysfunctional Attitudes Scale; BHIF =Baltimore How I Feel; DISC-IV =NIMH Diagnostic Interview Schedule for Children Version IV; CAPS =Child and Adolescent PerfectionismScale; CRSQ =Children's Response Styles Questionnaire; RADS =Reynolds Adolescent Depression Scale; PSI =The Problem-Solving Inventory; SSLES =Secondary School Students' Life

Events Scale; Harter's SPPC =Harter's Self-perception Profile for Children; PNMC =Peer Nominations Measure ofCompetence; TRS =Teacher's Rating Scale ofChild's Actual Behavior;PRS =Parental Rating Scale; PNMC =Peer Nominations ofMultiple Competencies; BPI =Berkeley Puppet Interview; PNID =Peer Nomination Index ofDepression; TRID =Teacher's RatingIndex of Depression.

R.H.Jacobs et al. / ClinicalPsychologyReview xx (2007) jccc-jccc 9

attributions than seventh graders, were more likely to catastrophize, and viewed themselves as flawed followingnegative life events (Abela& Payne, 2003). Consistentwith prediction, the interactionoflife events and attributionalstyle appears to be a more potent predictor of depression as children age (Abela, 2001; Conley, Haines, Hilt, &Metalsky, 2001; Nolen-Hoeksema, Girgus, & Seligman, 1992).Adolescents who demonstrate a positive attributionalstyle in sixth grade continue along the same linear trajectory (in the positive direction) over time (Garber et al., 2002).Similarly, adolescents who manifest a negative attributional style in sixth grade continue on a trajectory to a morenegativeattributionalstyle. Taken together, findings indicatethat childrenand adolescentsare capable ofdevelopingthe attributions that have been linked with depression. Longitudinal evidence suggests that as early as middlechildhood, negative attributions may place children on a trajectory toward an increasingly negative and perniciousattributional style.

The nature and strengthofassociations betweenattributional style and depressionmay vary with development infunction and/or content. We note Cole and TAimer's (Cole & Turner, 1993; Turner & Cole, 1994) suggestion thatattributional style mediates, rather than moderates, associations between life stress and depression in early- to mid-childhood. From this perspective, young children's negative attributions stem from adverse life events and areinternalized as negative attributional styles, creating vulnerability to depression. During adolescence, a more stableattributional style interacts with life stress to produce depressive symptoms (Cole & Turner, 1993; Turner & Cole,1994). Recent evidence supports this model. Attributional stylemediated andmoderated relations between life eventsand depression among fifth graders; whereas only a mediational role was presentin fourth graders (Gibb & Alloy,2006). Congruent with Cole and Turner's (1993; Turner & Cole, 1994) model, these observations suggest adevelopmental shift in the relations between cognition, life events, and mood.

On the otherhand,we note the 'weakest link* hypothesis, whichproposes that an individual'smostdepressogenicinference leads to vulnerability to depression (Abela & Sarin, 2002). As such, an individual's most depressogenicinference represents their degree of vulnerability. This model is descriptive in that individual attributions (global,stable, and self) appear relatively independentamong youth (Abela, 2001). In contrast, stability of the weakest linkamong youth is moderate (test retest reliability=0.38) across six weeks. The weakest link model allows for thepossibilitythat attributionalerrors can vary from settingto setting.In an investigationofthis hypothesis among seventhgraders, the interactionoflife stress by weakest link predicted increases in hopelessness depression symptoms (Abela& Sarin, 2002). Recent tests ofthis model are also supportive (Abela & Payne, 2003; Abela et al., 2006). As such, theweakest link hypothesis represents a refinement of attributional models of cognitive vulnerability, but would bestrengthenedthrough: 1) explicationofwhy a child would developone weak link, as opposed to another, and 2) how achild's weakest link may vary over time and across settings.

Developmental psychopathology models suggest that the cognitive, social, environmental, and self-regulatoryfactors associated with risk to depressiontransactionally influence oneanother. The integrationofreciprocal modelstothe study of attributional style represents an important conceptual advance. Latent factor growth modeling oflongitudinal data illustrates the parallelincreases in negative attributional style and depression severity. Adolescentswith initially higherand increasing levelsof depressive symptoms alsodemonstrate increasingly negative attributions(Garber, Keiley, & Martin, 2002). Attributional styleanddepression maybe mutually dependent In a comparison ofmediation, moderation, and reciprocal models, a reciprocal model gained the mostsupport, wherein initial levels ofdepressive symptoms predicted residual change in levels of stress and attributional style over the follow-up (Gibb &Alloy, 2006). Evidence alsosupports depression as leading tonegative attributional style(Bennett &Bates, 1995; Gibbet al., 2006; McCarty et al., 2007; Nolen-Hoeksema et al., 1992). In sum, reciprocal models allow for dynamicmodeling within a developmental psychopathology perspective.

Studies reviewed thus for support relations between attributions and depressive symptoms among youth.Attributions are related to past episodes and predict current and first episodes of depression (Lewinsohn, Clarke,Seeley, & Rohde, 1994). The interaction of life events and attributional style predict onset of MDD, but only athigh levels of stress (Lewinsohn, Joiner, & Rohde, 2001). In the only study of children, evidence did not supportattributional style as a vulnerability to MDD onset (Hammen, Adrian, & Hiroto, 1988). An attributional weakest linkdoes, however, predict depressive symptoms among children of depressed parents (Abela et al., 2006). Such findingsare preliminary and warrantreplication.

Turning to measurement, we note several developments. Almost every study reviewed uses the Children'sAttributional Style Questionnaire (CASQ; Seligman etal.,1984; CASQ-R; Kaslow, &Nolen-Hoeksema, 1991). Manyresearchers, however, call for better instruments, acknowledging the psychometric weaknesses of the CASQ. The

Please cite this article as: Jacobs, R.H., etal., Empirical evidence ofcognitive vulnerability for depression'among children and adolescents: Acognitive science and devetopmehtei perspective; Clinical Psychology Review (2007), doi:I0.1016/j.cpr.2007.10.006

10 RH. Jacobs et al. / ClinicalPsychologyReview xx (2007) xxx-xxx

CASQ measures attributional style in line with the reformulated theory of learned helplessness, rather than hopelessnesstheory.One new measure,the AdolescentCognitiveStyleQuestionnaire(ACSQ;Hankin& Abramson, 2002),assesses the entire negative attributional constructproposedby hopelessness theory. Moreover, the CASQ has poorinternalconsistency(coefficient alphas=0.4-0.6; Gladstone &Kaslow, 1995).Accordingto guidelines (e.g.,Nunnally& Bernstein, 1994), internal consistencies below 0.7 may lead to increases in Type II error. Recently developedmeasures includethe Children'sCognitive StyleQuestionnaire (CCSQ; Abela,2001)and the Children'sAttributionalStyleInterview (CASI; Conleyet al., 2001)allowfor more reliable assessment ofattributional style. Futureresearchcan rely on these more psychometrically sound measures, thereby increasing the likelihood of accurately detectingdevelopmental differences in attributional style.

It isnoteworthy, however, thatdespite measurement limitations, thebulkof thecurrent evidence remains supportiveofattributional styleas a cognitive vulnerability. Evidence is more consistent among adolescent, as opposed to child,samples. Research in this area will be facilitated by the recent development of structured interviews assessing theattributional styleof young children (Conley et. al, 2001).

3. Dysfunctional attitudes

Evidence supporting dysfunctional attitudes asavulnerability todepression derives from asetofstudies. Followingtheory, which places dysfunctional attitudes at thecenter oftheetiology ofdepression (Beck 1967,1983), prospectivestudies withadults support the role of dysfunctional attitudes in the development of depression (Alloy et al., 1999;Joiner, Metalsky, Lew, & Klocek, 1999; Kwon & Oei, 1994). Results from the Temple-Wisconsin CognitiveVulnerability to Depression project (CVD; Alloy et al., 2006) indicate that first onset of a depressive disorder issignificantly more likely among individuals with high levels ofdysfunctional attitudes and anegative attributional styleman among individuals with low levels of these cognitions. In another example, increases in depression symptomsresult fromthe interaction of dysfunctional attitudes and a negative university admissions life stressor among highschool seniors (Abela &D'Alessandro, 2002). These datasupportdysfunctional attitudes asa cognitive vulnerability todepression among adults.

3.1. Review

Six studies among youth (Abela & Sullivan, 2003; Lewinsohn et al., 1994; Lewinsohn et al., 2001; McCreary,Joiner, Schmidt, & Ialongo, 2004) prospectively assess the effects of dysfunctional attitudes on depression (seeTable 1). In all studies, dysfunctional attitudes, either alone or in interaction with life stress, predict depression. Theinteractionofdysfunctional attitudesand lifestresspredictsa diagnosisofdepressionat the levelofa trend (Lewinsohnet al., 2001).This exampleis a conservative test;however, as the effects ofimportantcovariatessuch as co-morbidnon-mood disordersand familypsychiatric historyare controlled. 'Pessimism' (which includesitems from Weissman andBeck's (1978)scale)predicts firstonsetofdepression(Lewinsohnet al., 1994).Higher levelsofdysfunctionalattitudesare observed among girls who met clinical cutoff scores for depression over the course of two years (Marcotte,Levesque, & Fortin, 2006). Overall, evidencesupports dysfunctional attitudes in the predictionofMDD among youth.

However, it is not clear that dysfunctional attitudes serve as a cognitive vulnerability strictly to first onsetdepression, since 'pessimism' is also associated with current and past depression (Lewinsohn et al., 1994). Moreperniciousand stable maladaptive cognitionsmay result fromrepeatedactivationduring episodesofdepressedmood.Dysfunctional attitudes may increase vulnerability to first onset of major depression during adolescence, as well asincrease vulnerability to future episodes. Parallel to findings within the attributional style literature, dysfunctionalattitudes may transactionally relate to mood.

Dysfunctional attitudes have not been explored in children until recently. This work is facilitated by thedevelopment ofthe Children's DysfunctionalAttitudes Scale (CDAS;D'Allessandro, & Abela, 2000). A test ofBeck'scognitivediathesis-stress theory ofdepressionrevealeda significant interactionofdysfunctionalattitudesby hassles,but only among children with high self-esteem (Abela & Sullivan, 2003). The self-esteem effect ran contrary tohypotheses.Anotherstudy identifieda significantinteraction- thistimein linewith hypotheses- amongchildrenwithhigh levels ofdysfunctional attitudes and low levels of self-esteemin the prediction ofmoderately severe depression(Abela& Skitch, 2007). Contraryto hypothesis, however, this interaction also appliedto childrenwith low levelsofdysfunctional attitudesand highself-esteem. Age didnot modifytheserelations despitechildrenas young as six being

Please cite thisarticle as: Jacobs, R. H.,et al, Empirical evidence ofcognitive vulnerability fordepression amongchildren andadolescents: Acognitivescienceand developmental perspective, Clinical Psychology Review(2007), doi:10.1016/j.cpr.2007.10.006

R.H.Jacobs et al. / ClinicalPsychology Reviewxx (2007) xxx-xxx 11

included, suggesting that young children can experience the deleterious effects of dysfunctional attitudes. In sum,studies with children yield complex results, which may bedue todevelopmental ormeasurement issues. Self-esteem inparticular appears to impact the way in which dysfunctional attitudes impact children at risk for depression. Withinadolescent samples, dysfunctional attitudes appear to represent a vulnerability factor; however, it has yet to bedemonstrated that the reverse relation is not also true.

4. Self-perception

A competency-based model asserts that negative events in a child's life lead to maladaptive self-cognitions thatpredispose achild todepression (Cole, 1990). Cole's model posits thatnegative self-perceptions regarding competencemay serve as a cognitive vulnerability factor for depression. This reasoning is congruent with cognitive models ofdepression inemphasizing self-schemata asproximal todepression onset (e.g., Abramson etal., 1978,1988). Negativeself-perceptions arebelieved to result from thenegative competency evaluations of significant others, such asparentsand teachers. A child's self-perception of competency may interact with others' appraisals to influence depression.Studies testing Cole's model represent a majority ofexisting research inthis area. We examine theexisting literature toevaluate self-perception as a cognitive vulnerability to depression in youth.

Definitional issues are important when reviewing this literature. Self-concept and self-esteem represent broadconstructs andencompass a range ofcomponents including cognitive processes, personality style, affective processes,andmotivational domains. Harter's (1985) scale of self-perceived competence isoneof themost frequently employedmeasures of self-esteem among youth. Germane to research on vulnerability for depression are scales assessingperceptions of personal competence, rather than omnibus measures of self-worth. Accordingly, we do not reviewstudies that include only Harter's general self-worth scale. This stems from a desire to incorporate a wide range ofpossible cognitive vulnerabilities, yet still restrict ourreview to cognitive, as opposed to personality, phenomena.

4.1. Review

Table 1presents prospective studies that explore self-perception anddepression. Evidence supporting negative self-perception as a proximal vulnerability to depressive symptoms is found in eight (Cole, Jacquez, & Maschman, 2001;Cole, Martin, & Powers, 1997; Cole, Martin, Powers, & Truglio, 1996; Hilsman & Garber, 1995; Kistner, Balthazor,Risi, & Burton, 1999; Measelle et al., 1998;Ohannessian, Lemer, Lemer, &von Eye, 1999; Tram& Cole, 2000)of thefourteen studies. Mixed evidence is found in threestudies (Cole, Martin, Peeke, Seroczynski, & Fier, 1999; Hoffman,Cole, Martin, Tram, & Seroczynski, 2000; Kistner, David-Ferdon, Repper, & Joiner, 2006), with an additional threestudies (Cole, Martin, Peeke, Seroczynski, & Hoffman, 1998; Lewinsohn et al., 1994; McGrath & Repetti, 2002)presenting evidence thatdepression predicts self-perception. Thus, theempirical base forself-perception asacognitivevulnerability in youth is decidedly mixed.

Evidence thatself-perception results from depression, or thattherelation may be reciprocal, is drawn from a fewwell-designed studies. Among fourth graders followed prospectively through sixthgrade, depression symptoms predictchange inchildren's negative self-evaluations (McGrath &Repetti, 2002). Reciprocal relations arealso illustrated inastudy of third and fifth graders (Kistner et al., 2006). Similarly, inaccurate self-perception predicts increases indepressive symptoms anddepressive symptoms, in turn, predict decreased accuracy in self-perception (Kistner et al.,2006). Academic overestimation predicts depression at many grade levels, but the reverse relation yields strongereffects (Cole, 1999). Underestimated competency predicts increases in depression within few grade levels; however,thereverse relation is found inallgrades (Cole, 1998). Partial support forreciprocal models is also found byHoffmanet al. (2000). These studies support thereciprocal, or transactional, relations between self-perception anddepression.

Yet anotherpossibility is that relations shift across development with self-perception leading todepression earlier indevelopment, while later indevelopment the opposite relation may emerge. Adevelopmental task ofmiddle childhoodisthe construction ofa personal sense ofone'sown competencies (Garber, 1984). Children may become increasinglycapable ofdrawing realistic judgments about their competence asthey grow. From a developmental psychopathologyframework, it is plausible that normative developmental stressors influence emerging perception regardingcompetence, thereby increasing riskof depressive symptoms (e.g., Cicchetti & Toth, 1998). As such, inaccurate ornegative self-perception may serve asa mediator of the relation between life stress and depression. Tram and Cole(2000) assessed these effects among ninth graders. Support was consistent for a mediational model whereby negative

Please cite this article as: Jacobs, R. H., etaL, Empirical evidence ofcognitive vulnerability for depression among children and adolescents: Acognitive science anddevelopmental perspective, Clinical Psychology Review (2007), doi:10.1016/j.cpr.2007.10.006

12 RJI. Jacobs et al. / Clinical Psychology Review xx (2007) xxx-xxx

events predicted changes inself-perception, and self-perceptionpredicted changes indepressive symptoms. Incontrast,little evidence for moderation emerged. Inthis regard, self-perception may represent a mechanism, whereby salient lifeevents affect mood.

Few studies examining relations between self-perception and mood have included simultaneous assessment of lifeevents. This issurprising and may contribute todiscrepant findings, asadverse events may benecessary to activate achild's latent negative self-perception inaparticular domain. Inone study, a 'grade deficit stressor' was employed inasample ofsixth graders wherein children were asked todefine their own level ofacceptable grades (Hilsman &Garber,1995). Children with negative self-perception of their academic achievement expressed more depressive symptomsafter receiving unacceptable grades than did students without negative self-perception. The inclusion of life stressassessment inthe study ofself-perception must beincorporated in future research toadequately test the role ofself-perception as a cognitivevulnerability fector.

We propose that the presence ofreciprocal, ortransactional, relations between self-perception and depression mayaccount forthemixed state oftheliterature. Findings may also differ depending onwhich aspects ofself-perception arestudied, at which points of development assessments are conducted, and what levels of baseline depression areincluded. Temporal and causal precedence have not yetbeen well-established. The literature offers support for self-perception ascontributing to depression, butoffers parallel support for self-perception asresulting from depression.Self-perception does not predict onset of first-episode MDD among youth (Lewinsohn etal., 1994). Seff-perceptiondoes, however, relate to current and past depression. Thus, it is currently unclear whether Cole's (1990) modelmaps well onto a clinical diagnosis ofdepression. The possibility remains mat self-perception may simply representaconcomitantofdepressed mood. We also believe, inline with Cole (1990), that early indevelopment, self-perceptionmay serve as a mechanism, whereby life events affect levels of depression. That is, negative self-perception maymediate thisrelationship. Later in development, self-perception may come to moderate thisassociation.

Methodological difficulties may also contribute to discrepancies between studies. Harter's (1985) measure,although systematically constructed from a strong conceptual base, may contribute to divergent findings. Somesubscales demonstrate minimally acceptable reliability (Harter, 1985), warranting psychometric refinement Harter's(1985) multifeceted scale may also lead to confusion among younger children. Researchers may wish to use thePictorial Scale ofPerceived Competence and Acceptance for Young Children (PSPCSA; Harter, 2002; Harter &Pike,1984), which does not rely entirely onlanguage comprehension and allows for assessment ofyoung children. Lastly, itispossible that the construct ofself-perception istoo conceptually broad. Theoretical coherence inthis area ofstudymay lead to more congruent findings. In sum, research on self-perception among youth has not conclusivelyestablishedwhether it representsa cognitivevulnerability fector.

5. An integrative perspective

Overall, this body of literature implicates several cognitive factors in vulnerability for depression among youth.As we have seen, research to date is not definitive andhas produced complex results. Over-reliance on self-reportmeasures is a notable weakness. It is clear that children are capable of experiencing the type of cognitions underdiscussion; however, whether or nota child canreliably hold these cognitions consciously in mind andreport them iscurrently debatable. Similarly, thequestionable reliability of extant measures is problematic.

Due tothese challenges, wepropose thatincorporating informationprocessing paradigms into thestudy ofcognitivevulnerability allows for a more developmentally sensitive and adequate test Indeed, we note that Clark and Beck(1999) define the cognitive model "as an information processing theory... understood in terms of the structures,processes, and products involved in the representation and transformation of information" (pp. 109-110). Accordingto the cognitive model, biases in information processing are core aspects of depression. Information processingparadigms, such asthe Stroop and dot-probe tasks, measure cognitive processes outside ofthe child's awareness. Suchmeasures may offer more objective tests of cognitive operations, while also allowing forexperimental manipulation.Lower order phenomena, such asattentional biases, may represent themechanisms thatlead tocognitive vulnerabilityproducts. If this is thecase, thedevelopmental study ofthese processes would allow researchers to explore theoriginsof maladaptive cognitions. Moreover, information processing biases may represent markers for broader cognitivevulnerability factors. Studies incorporating both self-report cognitive content and information processing paradigms allow researchers to refine cognitive vulnerability models, fostering theoretical andempirical advancements inpsychopathology research.

Please citethisarticle as: Jacobs, R. H.,et aL, Empirical evidence of cognitive vulnerability for depression among children andadolescents: Acognitive science and developmental perspective, Clinical Psychology Review (2007), doi:I0.1016/j.cpr.2007.10.006

R.H.Jacobs et al. / ClinicalPsychology Reviewxx (2007)xxx-xxx 13

On the other hand, information processing paradigms often suffer from questionable reliability and validity.Relations between theoretical constructs and information processing paradigms are oftenunclear(Vasey, Dalgleish, &Silverman, 2003). Convergent validity withother measures hypothesized to tapsimilarunderlying concepts is lacking.Similarly, little is known about the reliability of information processing measures (Vasey et al., 2003). This lowreliability canreduce statistical power (e.g., Nicewander &Price, 1983). Moreover, asVasey etal.(2003) point out,theclinical utility of these measures inchildren is notestablished. Nevertheless, information processing paradigms offer avaluable framework for conceptualizing and studying cognition in psychopathology (Vasey et al., 2003). Whileexperimental paradigms have pitfalls, they donothave the same pitfalls asself-report methods. It is likely thathigherorder andlower order cognition reciprocally relate inthedevelopment ofspecific cognitive vulnerabilities. Aswehaveseen, topdown cognition constrains themanner in which information is processed at lower levels of thesystem, andvice versa (e.g., Dalgleish, 2002). The consequences of these two processes in interaction may be greater thaneithercognitive process inisolation. Integration ofthese methods would allow for theassessment of such interactive effects.

Anintegrative cognitive approach tovulnerability for depression represents acritical step inestablishing acognitivescience base to guide empirically supported treatments (e.g., Cacioppo et al., 2007; Matthews, 2006). In order toadvance this integrative perspective, webriefly review the information processing literature testing emotional stimuli inchildren and adolescents. The information processing studies we review are not longitudinal. However, we explorecross-sectional findings and discuss how these paradigms can be applied to the study of cognitive vulnerability.Samples include children and adolescents with a diagnosis of depression, varying levels of depressive symptoms,recovered depressed, and children of depressed mothers. We do not review the procedures involved in informationparadigms, butrefer the reader to Matthews and MacLeod (1994) and Garber and Kaminski (2000).

5.1. Review

Table 2presents studies ofinformation processing biases and depression among children and adolescents. Level ofdepression isassociated with greater recall ofnegative information relative topositive information inyouth (Bishop,Dalgleish, &Yule, 2004; Cole &Jordan, 1995; Drummond, Dritschel, Astell, O'Carroll, &Dalgleish, 2006; Rudolph,Hammen, &Burge, 1997; Taylor &Ingram, 1999; Zupan, Hammen, &Jaenicke, 1987; for null results see Dalgleishet al., 2003; and Hammen & Zupan, 1984). This association is also found among children and adolescents with adiagnosis ofMDD (Neshat-Doost, Moradi, Taghavi, Yule, &Dalgleish, 2000). Depressed youth demonstrate higherrates ofrehearsalofnegative memories (Kuyken &Howell, 2000). Theyrecall positive information less well (Whitman& Leitenberg, 1990) and reveal significantly fewer positive autobiographical memories (Drummond et al., 2006).Lower rates ofpositive adjective endorsement also occur among psychiatric inpatient youth (Gencoz, Voelz, Gencoz,Pettit, &Joiner, 2001). Furthermore, depressed youth rate more negative words as self-descriptive (Timbremont &Braet, 2004). Youth atrisk for depression demonstrate memory biases for negative self-descriptions (Hammen, 1988).These self-descriptions can interact with life stress to result in onset or exacerbation of depression (Hammen &Goodman-Brown, 1990). Insum, information processing paradigms reveal abias toward negative stimuli among youthwith symptoms or a diagnosisofdepression.

Information processing paradigms also highlight overgeneral memory biases among depressed children andadolescents (Kuyken, Howell, & Dalgleish, 2006; Park, Goodyer, & Teasdale, 2002). Rumination appears toexacerbate this effect (Park etal., 2002). There isalso evidence that depression impairs the memory ofnegative events.Children and adolescents with clinically significant levels of depression (as measured by the CDI) show impairedmemory for negative events (Hughes, Worchel, Stanton, Stanton, &Hall, 1990). Depression severity is also related toless specific negative memories among adolescents in residential treatment (Swales, Williams, & Wood, 2001).Deficits inmemory for fearful feces are exhibited among children ofdepressed parents (Pine etal., 2004). Incontrastno such effect is found in reaction times to the detection of threatening versus non-threatening faces (Hadwin et al.,2003). Lastly, depressed youth present with significantly longer reaction times to negative emotional working memorytasks compared to neutral tasks (Ladouceur et al., 2005). Thus, depression is related to memory biases in youth, butthese relations arecomplex and worthyof additional study.

Research regarding relations between deployment ofattention and mood issimilarly complex. More attention isgiven to negative stimuli by depressed youth than the non-depressed (Kyte, Goodyer, &Sahakian, 2005), and slowerresponse rates on an attention cuing task are found among childrenofparents with depression (Perez-Edgar, Fox, Cohn,&Kovacs, 2006). However, studies with attentional dot-probe tasks for words do not support attentional biases in

Please cite this article as: Jacobs, R.H., etal., Empirical evidence ofcognitive vulnerability for depression among children and adolescents: Acognitive science and developmental perspective, Clinical Psychology Review (2007), doi:10.1016/j.cpr.2007.10.006

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Information processingamong youth

Study N Age Depression Samplemeasure

Cognitive measure Summary of findings

Bishop etal. 121 (5-11)(2004)

Cole and

Jordan

(1995)Dalgleish 80

etal. (1997)

394 (9-15)

(9-18)

DSRS

CDI

DRSS

Dalgleish et al. 71 (9-18) MFQ(1998)

Dalgleish etal. 67 (7-18) DSRS(2003)

Drummond 70 (7-11) CDIet al. (2006)

High and low non-clinicallydepressedchildren as assessed by DSRS)from school

School

15 diagnosed depressed, 22 diagnosedanxious, 43 controls

24 recovered depressed (K-SADS) and 47school control

MDD, PTSD, GAD patients and schoolcontrol

School sample with CDI

Emotional stories

recall task

Incidental recall

Dot probe, Stroop,subjectiveprobability, andword memorySubjectiveProbabilityQuestionnaireDot probe, Stroop,subjectiveprobability, andword memorycutoff AMT

Gencoz et al. 58 (9-17) CDI Psychiatric inpatients with various chart SRET

(2001) diagnoses,44% non-bipolarmoodHadwin et al. 38 in (6-10) CDI School Visual search for

(2003) exp 1 threatening and non-threateningfaces

Hammen 79 (8-16) CDI, 16 children ofdepressed mothers, 10 of Self-Schema Task

(1988) K-SADS bipolar, 18 ofmedically ill mothers, 35 ofnormal

Hammen and 64 (8-16) K-SADS 12 children of depressedmothers, 12 of Self-Schema Task

Goodman- bipolar, 14 ofmedically ill, 26 ofnormalBrown

(1990)Hammen and 61 (7-12) CDI School Incidental Recall,

Zupan Self-Schema Task,

(1984)Hughes et al. 322 (10-13) CDI, School with cutoff Recall and

(1990) PNID recognition

Higher depression showed enhanced recallofnegative storiesrelative to positive storiescomparedto low depressed group.

Higher depression recall fewerpositiveself-referential words,onlysignificant in grade 8.

Depressed estimatednegativeevents equallylikely to happentothem as others.

Recovered depressedratenegative events as less likely to occur,allestimated negative more likely to happen to others than themselves.

No depression biases in comparison to other groups, but depressedgroup was significantly higher than otherson anxiety self-report

Young dysphoric children recallmore specific negative and fewerspecific positive. Older dysphoric difficulty in retrievingspecificnegative memories. In general,children's specific negative recallimproveswith age. Dysphoric bad significantly fewerpositiveAMs.

Lowerratesof positiveadjectiveendorsement andrecall associatedwith depression, but not anxiety.No effects ofdepression on searchtime.

When controlling for baseline CDI, trendtowardself-schema scoresas predictorofaffective diagnosis.

Significant association between onsetor exacerbation of depressionand the experienceof stressors relevant to child's self-schema.Particularly markedeffect forchildren of depressed mothers.

Non-depressed higherproportion ofpositive self-descriptive words(but not significant), no evidenceofnegative biasin depressed.

Significant interaction between group status andvalence of storyevents forrecognition. Depression symptoms impair memoryfornegative story events.

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Joorman et al. 41 (9-14) CDI-S

(2007)

Kelvin et al. 102 14.0 MFQ(1999)

Kuyken and 65 (12-18) BDI-H

Howell

(2000)Kuyken et al. 62 (12-18) BDI-II

(2006)Kyte et aL 79 15.3 MFQ

(2005)

Ladouceur 75 (8-16) CDI, BDI

et al. (2005)

Martin et al. 63 3rd and CDI

(2003) 6th

gradersMurray et al. 95 5.0 None

(2001)Neshat-Doost 64 (9-18) CDI, MFQ

et aL (1997)

Neshat-Doost 38 (10-17) CDI, DSRS

et aL (1998) MFQ

Neshat-Doost 55 (9-17) DSRS

et al. (2000)Park et al. 155 (12-17) MFQ,

(2002) HDRS

Park, Goodyer, 134 (12-17) MFQ,

and HDRS

Teasdale

(2004)Perez-Edgar 33 (6-10) None

et al. (2006)

Pine et al. 152 (9-19) PARIS

(2004)

21 girls ofmotherswith recurrent MDD, 20 Dot probewith facesgirls ofmothers with no history ofAxis 1

AMALSS with prime

AMT

AMT

CANTAB, WCS,affective Go-No-Go,decision makingEmotional n-back

(working memorytask)

Emotional Stroop withnegative social words

Verbal and nonverbal

expressions card gameStroop

High risk daughters selectively attendedto negative facialexpressions.Controldaughters selectively attended to positive facialexpressionsAdolescents with high emotionality endorsed morenegativeself-descriptorsafter a dysphoric, but not neutral,mood induction.Depressed more likely to retrievememories fromobserverperspective andmorerecenttime period. Also rehearsed negativememories and ratedas more personally important.MDD andno trauma demonstrated overgeneral memory bias.

Depressed greater attention to sadstimuli,moreimpulsivewhenmaking decisions.

MDDandco-morbid significantly longer reaction timeson negativeemotional backgroundscompared to neutral.

Forunpopularchildren,greater friendship valuingand greaternegative social word Stroop interferencepredictedincreasesindepressive symptoms across6 months.When dealt a losing hand, exposed childrenmade more negativeexpressions compared to non-exposed children.No significantdifferences.

Community sample defined as atrisk by level of emotionalityDSM-IV diagnosis ofMDD recruitedfromcommunity

DSM-IV diagnosis from SCID recruitedfrom community30 patientsdiagnosedwith first onsetMDD (K-SADS) and school control

16 MDD diagnosed(K-SADS) frominpatient and outpatient clinics: 17 anxiety,24 co-morbid depressionand anxiety, 18low-risk normal control recruited from

communityChildren with low and high peer-ratedpopularity

55 children ofmothers with depression(SADS-L) and 40 control19 DSM-IV/ICD-10 depressed, CDI, MFQcutoff, 19 mixed anxious/depressedand 26controls recruited from clinics

19 patients with ICD-10 diagnosis andcutoff score on CDI, DSRS, and MFQand 19 school controls

19 with DSM-IV MDD diagnosis, 24school controls

96 clinically referred adolescents withMDD, 26 non-depressed psychiatric,and 33 community controls (K-SADS)75 first onset MDD, 26 non-depressedpsychiatric assessed (K-SADS-PL) and33 community controls

Recallandrecognition Depressed grouprecalled significandymorenegativeadjectives, thismemory tasks

Attentionaldot-probetask

AMT

depressionrelated bias became strongerwith age. No bias inrecognition task.No support for attentional bias.

Adolescentswith current MDD more categoric overgeneralmemories than controls,but not more thannon-depressed.

Rumination increased overgeneral memoriesto negativecuesin MDD patients.

a'

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AMT with prime

16 children of parents with child onset Posner task underdepression (COD) diagnosed (SCID) versus neutraland affectivecommunity control conditions19 children of depressed parents (SCID) Facememory taskand 133 anxiety or healthy

Children of parents with COD were slower in theirresponseratescompared with control children, subtle deficits in selective attention.

MDD offspring significantdeficits in memory selectively for fearfulfaces, but not happy or angry faces. MDD not associated withface-memory accuracy.

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Table 2 (continued)

Study JV Age(range)mean

Possel et al. 92 (13-15)(2006)

Prieto, Cole, 50 (8-12)and Tageson(1992)

Reid et al. 133 (8-14)(2006)

Rudolph et al. 81 (8-12)(1997)

Swales et al. 46 14.2

(2001)Tagbavi et aL 67 (9-18)

(1999)

Taylor and 86 (8-12)Ingram(1999)

Timbremont 44 (8-16)and Braet

(2004)Vrielynck, 60 (9-13)

Deplus, and 11.5

Philippot(2007)

Whitman and 52 4th-6th

Leitenberg grade(1990)

Zupan, 81 (8-16)Hammen,

and Jaenicke

(1987)

Depression Samplemeasure

Cognitive measure Summary of findings

SBB-DES School children divided into groups basedon depression measure

CDI 15 clinic-depressed, 18 clinic-non-depressed,and 17 control children

CDI School

SRET No significantdifferenceson SRET.

Significandy more positivewords recalled by non-depressed children.This relationdid not hold after effects ofword recognitioncontrolled.

Psychopathology (externalizing andinternalizing) was associated withhypervigilance for threat cues,negative interpretations of socialsituations, internal attributions, perception ofhostile intent, and recallofnegative self-descriptions. Noneof these relations were specificto depression.Depressed children significandy greater recall of negative maternalCDI School

BDI Residential patients with ICD-10psychiatricdiagnosis and school control

DSRS 24 anxious, 19 mixed anxious-depressedprimary diagnosis DSM-IV, 24 normalschool controls

CDI 40 offspring ofdepressed mothers(SCID) high-risk and 46 low-risk

CDI 19 depressed, 15 never depressed, and 10remitted depressed (CDI cutoff)in residential facility

MDI-C 15 depressed children, 25 never depressedclinical, and 20 control

CDI 26 with score at least 1 SD above normative

mean on CDI and 26 school controls

CDI 20 children ofwomen with depression(K-SADS), 21 not depressed

Self-Schema Task

Self-Schema Task,Attentional dot probe,Attribution vignettes

Story task with recallandlevel of processing attributes thannon-depressed on recall from storytask.Non-task

AMT

Attentional dot-probetask

SRET with prime

depressed demonstrated greater recall of positive attributes on levelofprocessingtask.Moredepressed less specific,but many patients recalling the sametraumatic memory (parasuicide) over andover.No attentionalbias in mixed anxious-depressed children.

Primed at risk children demonstrateda less positive self-concept anda higher proportion ofnegative endorsed words recalled.

SRETwith prime Remitted depressed rated more negative words asself-descriptive.

AMT Depressed children gave fewerspecificmemories.

Word association task Evidence that depressedrecall positiveless well.

Self-schema incidental

memory taskDepressed demonstrated recall of negative self-descriptive adjectives.

Note. Ageranges and means reported when available. Grades reported when age data was not available. AMT =autobiographical memory task; SRET =self-referent encoding task; AMALSS =Assessment ofMood Activated Latent Self-schema; CANTAB =Cambridge Neuropsychological Test Automated Battery, WCS =Wisconsin Card Sorting Task; DSRS =The Depression Self-RatingScale; K-SADS =Schedule for Affective Disorders and Schizophrenia for School-Age Children; CDI =Children's Depression Inventory; SCID =Structured Clinical Interview for theDiagnostic andStatistical Manual for Mental Disorders; SADS-L =Schedule for Affective Disorders and Schizophrenia — Long; MFQ =TheMood and Feelings Questionnaire; ICD-10 =International StatisticalClassification of Diseases and RelatedHealth Problems 10thRevision;DSM-IV = Diagnostic and Statistical Manual of MentalDisorders — 4th edition.

: /: '. .':;!

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R.H.Jacobs et al. / ClinicalPsychology Reviewxx (2007)xxx-xxx 17

depressed youth (Dalgleish etal.,2003; Neshat-Doost et al.,2000; Taghavi, Neshat-Doost, Moradi, Yule, & Dalgleish,1999). Children with MDD are more easily distracted by negative pictures than neutral pictures, whereas controlchildren are more distracted by positive pictures (Ladouceur et al., 2005). Moreover, recent work suggests thatdaughters of depressed mothers selectively attend to negative facial expressions, whereas control daughters selectivelyattend to positive fecial expressions (Joorman, Talbot, & Gotlib, 2007). In this study, a dot-probe taskwasused, butfecesinsteadofwords were selectedas stimuli.Ofnote, fecialexpressionparadigmsresult in moreconsistentfindingsthan verbal within the adult literature, as do studiesusing longerstimulusdurations(e.g., Gotlib et al., 2004). In sum,relations betweendepression and attentionin youth are not yet well understood.

This body of literature affirms that symptomatically depressed youth demonstrate memory and attention biases.However, thesestudies areoverwhelmingly cross-sectional anddo not explicate whether thesebiases contribute to theetiology or maintenance of depression. Results from longitudinal studies with adults suggest that informationprocessing paradigms may reveal key processing biases underlying depression. Cognitive biases predict change indepressive symptoms in community samples (Rude, Wenzlaff, Gibbs, Vane, & Whitney, 2002). Pregnant mothersrecalling more negative words ona self-referential encoding taskdemonstrate more symptoms ofdepression followingchildbirth (Bellow & Hill, 1991). Among adults with MDD, greater recall of positive words on the self-referentialencoding taskuniquely predicts a decrease indepression symptoms (Johnson, Joorman, &Gotlib, 2007). A tendency toshift attention toward negative information following anemotional prime interacts withlife stress topredict increases insymptoms of depression seven weeks later (Beevers & Carver, 2003). Thus, there is good evidence that informationprocessing paradigms are useful in predicting depression longitudinally among adults.

Among theyouth-focused information processing research, only one study followed participants longitudinally andtested relations with depression (Hammen, 1988). A child's memory bias toward negative self-descriptions predictedaffective diagnosis across sixmonths (Hammen, 1988). However, this relation was onlyobserved atthelevel ofa trend.Ina related literature, Martin et al. (2003) observed higher levels of Stroop interference among children whoattachedgreater importance to friendships and whose peers rated them as having few friends. This interference predictsincreases indepressive symptoms over a six month period. Martin and colleagues propose that the Stroop paradigmmay be more sensitive to children's social concerns than traditional paper-and-pencil measures. A limited body ofevidence suggests that information processing paradigms may predict depression across time. Clearly, more research isnecessary to establish the prospective relations between these lower order processes and depression among youth.

The relations between information processing and cognitive content measures are relatively unknown among youthas well. Inan adult example, individuals athigh cognitive risk for depression inthe CVD exhibited more self-referentinformation processing biases than individuals with low cognitive risk (Alloy, Abramson, Murray, Whitehouse, &Hogan, 1997). Similarly, among high cognitive risk participants, the self-referent information processing task battery(SRIP; Alloy et al., 1997) partially mediated cognitive risk effects (Steinberg, Oelrich, Alloy, & Abramson, 2004).Within the same sample, the negative SRIP composite interacted with cognitive risk to predict first onset, but notrecurrence ofdepression. While there is some evidence that these constructs relate among adults, how these cognitiveprocesses relate among youth is currently unknown. A recent study (Reid, Salmon, &Lovibond, 2006), however,interviewed children about their attributional style and gathered data on attention allocation and memory recall.Information processing and cognitive content biases were congruent and associated with psychopathology, althoughnot to depression specifically. The integrative study of information processing biases and cognitive content vulnerabilities may result in theoretical refinement of cognitive models of depression among youth.

We conclude that information processing paradigms offer auseful tool for investigating cognitive vulnerability fordepression among youth. However, the information processing studies reviewed assess youth with a range ofinternalizing diagnoses. Many ofthese studies did not propose specific hypotheses inrelation to differing diagnoses,clouding the theoretical utility of results. Moreover, a notable distinction between the cognitive content andinformation processing literature is the use ofemotional priming. Emotional priming - the experimental induction ofmood for the purposes oftapping latent cognition - isused successfully within the information processing literature,but has not yet been incorporated into prospective longitudinal studies ofcognitive vulnerability among youth. On theother hand, information processing studies rarely investigate the effects oflife stress onthe accuracy ofinformationprocessing. Emotional priming prior to measuring cognitive content via questionnaires allows for amore powerful andadequate test ofcognitive vulnerability models, as the induction ofa negative mood state may allow individuals toreport latent schema (e.g., Persons &Miranda, 1992). Integrating the assessment ofstress, orimplementing astressor inthe lab, would similarly result inan effective assessment ofcognitive biases within information processing paradigms.

Please cite this article as: Jacobs, R.H.; etaL; Empirical evidence ofcognitive vulnerability for depression among children and adolescents: Acognitive science and developmental perspective, Clinical Psychology Review (2007), doi: 10.1016/j.cpr.2007.10.006

18 RH. Jacobs et al. / Clinical Psychology Review xx (2007) xxx-xxx

Consequently, acombinationofinformation processing paradigms and self-reportquestionnaires permits researchers toevaluate whether these higher and lower level cognitions do, in fact, influence one another in the development ofpsychopathology.

6. Discussion

Several cognitive models ofvulnerability for depression have been proposed during recent years, and have attractedempirical attention. Derived from research on cognitive concomitants ofdepression among adults, they propose that theestablishmentofmaladaptive schema, negative attributional style, and impaired self-perception may place youth atriskfor major depression. Although evidence supporting each ofthese models has emerged, conceptual challenges remain,and no single model adequately accounts for the full range offectors implicated inrisk for depression.

We envision significant advances in our understanding of cognitive vulnerability for depression through theincorporation ofinformation processing paradigms into existing models. Capturing the relations between vulnerability fectors and depression may be facilitated through the study ofyouth within acognitive-developmental framework.Interdisciplinary collaboration between developmental and clinical scientists will allow for broad conceptualintegration.

The use of emotional priming strategies and methodologies borrowed from research in experimental cognitivepsychology may shed light on cognitive vulnerability fectors among young children. According to Beck etal. (1979),schemata "may be latent but can be activated by specific circumstances which are analogous toexperiences initiallyresponsible for embedding the negative attitude" (p. 16). Germane toa discussion oflatent schemata, the mood-statehypothesis proposes that cognitive vulnerabilities are accessible only during negative mood states (Persons &Miranda,1992). This hypothesis is based on an associative-network model in which mood states cue related thoughts(e.g., Bower, 1987). Persons and Miranda (1992) argue that, because depressogenic cognitions develop when oneexperiences negative affect, cognition and affect are linked in memory. When not experiencing a negative mood,cognitions related to negative affect may be inactive. Adolescents may experience more negative life events thanchildren (e.g., Ge et al., 1994), offering opportunities for latent cognitive schemata to become activated. Theloweraverage rates ofstress inearly childhood raise the possibility thatcognitive vulnerability fectors may bepresent, butnotactivated. I£ despite emotional priming, cognitive vulnerability factors donot appear tobeassociated with depressivesymptoms among children as they are with adults, a developmental difference would be identified. Given thepossibility that lower order andhigher order cognition appear to develop in tandem andreciprocally influence oneanother, the inclusion of information processing paradigms will clarity the role of lower order and higher ordercognitive vulnerabilities. In sum, latent measurement of cognitive vulnerability through information processingparadigms may allow fora broader understanding ofcognition inpsychopathology andaddress theoretical hypothesesregarding cognitive vulnerability models.

Have the theoretical hypotheses of cognitive vulnerability models gained strong support in studies of youth (e.g.,Alloy et al., 1999; Ingram et al., 1998)? First, the stability of cognitive vulnerability factors among children andadolescents remains unclear. Datasuggest thata degree of stability exists withinadolescent samples, whereas amongpre-pubertal youth, onlyshort term stability of cognitive content have beenreported. We note thatJustet al. (2001)question theassumption thatcognitive vulnerability represents an immutable trait We propose that in thedownwardextension of cognitive vulnerability models to youth, allowance mustbe made for the variable nature of developingcognition. Second, findings to date have not demonstrated temporal precedence of proposed cognitive vulnerabilityfectors. Future research must assess prior episodes and follow young samples to make the detection of thesephenomena feasible and likely. Third, research suggests that a number of cognitive fectors may be implicated invulnerability fordepression. These factors have rarely beenexamined simultaneously within thesame sample. Little isknown, men, about howtheymay interact inplacing youth atriskfordepression. Literatures surrounding each of theputative riskfactors haveevolved independently. Synthesis, through integrative research paradigms is needed. Fourth,some evidence has emerged for the specificity criterion (e.g., Gencoz et aL, 2001; Robinson et al., 1995). Given thecentrality of this hypothesis to cognitive models of psychopathology, additional research is needed. Last, theendogenous and latent nature of cognitive vulnerability in youth is likely. Cognitive vulnerability factors appear toreside within the child. However, an increased attentionto ecologically valid life stress assessment, as well as theincorporation of information processing paradigms and emotional priming into research design, allows for morethorough investigation. In sum,the central hypotheses of cognitive vulnerability models haveyet to be put to the test.

Please citethisarticle as: Jacobs, R. H.,et aL, Empirical evidence ofcognitive vulnerability fordepression among children andadolescents: Acognitive scienceand developmentalperspective, ClinicalPsychology Review(2007),doi:10.1016/j.cpr.2007.10.006

R.H. Jacobs et al. / Clinical PsychologyReview xx (2007) xxx-xxx 19

We believe cognitive vulnerability research incorporating information processing paradigms will more adequatelyaddress these theoretical hypotheses.

6.1. Future research

Several lines ofresearch will advance study and are detailed in Table 3. Framing the study ofcognitive vulnerabilitywithin the broader domain ofcognitive development will be essential. Age is, at best, a crude marker ofontogeneticchange (Rutter& Sroufe, 2000). Specific markersofcognitivedevelopmentmust be realized. Sensitivitymust be givento how depressionand cognitive vulnerabilitymanifestin relationto the developmentofcognitivecapacities and theattainments of childhood and adolescence (Cicchetti & Rogosch, 2002). In addition to the integration of informationprocessing paradigms, the inclusion of neuropsychological measurement will be informative. Tracking normativetrajectories of cognitive and brain maturity will embed research on the etiology of mood disorders within adevelopmental context.For example,a widely used tool, the Cambridge Neuropsychological TestAutomatedBattery(CANTAB; see http://www.camcog.com), assesses executive functioning (for an example see Kyte, Goodyer, &Sahakian, 2005). Such measurement allows for analysis of specific links between changes in depression and thedevelopmentofcognitive abilities, hi sum, these linesofinquiry move scientists and clinicians toward a cognitive anddevelopmental base for the study and treatment ofpsychopathology.

In addition, integration with research in developmental biology and functional neuroimaging will advance ourunderstanding of the development of psychopathology among youth. For example, Cortisol and psychophysiologyassessment within studies of cognitive vulnerability may promote the identification of possible phenotypic andendophenotypicmarkers ofrisk (e.g., Gottesman & Gould, 2003). As Bearden and Freimer (2006) note, the study ofheritable traits that can be reliably measured is fruitful in the study of psychiatric disorders. Identifying specificprocesses and behaviors, or 'behavioral endophenotypes', advances the study of psychopathology (Cacioppo et al.,2007; Prathikanti & Weinberger, 2005). In line with this argument, information processingparadigms may allow forpre-morbid identification of vulnerability at younger ages. Linking these literatures is imperative work for psychopathology researchers.

The study ofcognitive models ofvulnerabihty for depressionhas illuminatedmechanismsand factors important foradolescent health. Much work, however, remains. This area is complex whereby individual, group, developmental,biological, and environmental fectors impact cognition and depression. What is clear from existing cognitivevulnerability research is that adolescence represents a phase wherein cognitive vulnerability is likely to becomeapparent. However, giventhe presentdifficulty establishing temporalprimacyofcognitivediathesesto depression, werecommend research with younger populations (e.g., ages 7-12 years) that incorporates information processingparadigms. A developmental framework permits assessment of the child, accounting for their stageof growth within

Table 3

Recommendations for further research

Assessment • Community children followed from middle childhoodthroughentry to middle schooL• Careful assessment of priordepression episodes to distinguish vulnerability from scar.• Attentionto pubertal maturation, cognitivedevelopment, latent andexplicitmeasures ofcognitivevulnerability andstress.• Onset of clinical disorder assessed every six months.• Youth followedthrough remission andrelapse to establish whethervulnerabilities apply to firstonset only.• Study ofrumination and problem solving as possiblecognitivevulnerabilities.• Integrationof emotional priming and information processingparadigms.

Analyses • Mapnormal andabnormal trajectories through growth mixturemodeling to increase the likelihood thatreciprocal effectsbetween cognition and mood will be captured.• Analyseswhich account forinitiallevelofdepression, asmodelsmay only apply to asymptomatic at baseline sub-samples.• Integrative and transactional models(e.g. Hankin & Abramson, 2001)assessing the rolesofvulnerabilities in relation to oneanother.

Interdisciplinary • Establish developmental trajectories and'normal benchmarks' ofcognitive processes, allowing cognitive vulnerability factorscollaboration to be distinguished from normative developmentaldifferences.

• Cortisolassessmentallowing for integration with biological underpinnings ofdepression.• Establish a taxonomy systemwith established agenorms for stress (Grant et aL, 2004a) to facilitate developmentalframeworks andallowforcomparison of stressors across samples.

Please citethisarticle as: Jacobs, R. H.,et aL,Empirical evidence ofcognitive vulnerability fordepression among children andadolescents: Acognitive science anddevelopmental perspective, Clinical Psychology Review (2007), doi:10.1016/j.cpr.2007.10.006

20 RJI.Jacobs et al / Clinical Psychology Review xx(2007) xxx-xxx

the dynamic, continuous, and reciprocal interactions ofthe environment Such investigation firmly places cognitivevulnerability research within the developmental psychopathology perspective. Not only will this work advance thescientific study ofpsychopathology, but itwill produce implications for treatment and prevention ofdisorder amongyouth (e.g., Cacioppo et al., 2007; Matthews, 2006).

Acknowledgements

Preparation of this manuscript was supported bya F31 (MH075308) toRachel H. Jacobs.

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